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Colorado Cancer Resource

Swedish Medical Center offers ammunition against growing menace

David Holmberg enjoying Boulder’s Flat Irons

David Holmberg made all of the tough changes: Starbucks? Scratch it. Weekend brews? No way. McDonald’s? Not in this life. But no matter what he cut from his diet, and regardless of how many acid-reducing pills he popped, the Fort Collins resident couldn’t smother his chronic heartburn, which disrupted his days for more than five years with sore throats, sinus congestion, chest discomfort and voice problems.

“I was volunteering in Central America and having a lot of issues with chronic laryngitis,” says Holmberg, 27, a nursing aide who plans to finish a physician assistant’s degree at Colorado State University. “I would lose my voice for long periods of time. So in addition to the discomforts of heartburn, I could hardly communicate. I cut out caffeine, alcohol, fast foods, fatty foods, and no matter what I did, it wasn’t enough.”

Doctors say Holmberg’s situation has become all-too common, with gastroesophageal reflux disease reaching every age group and topping the health-issue charts. In response, Swedish Medical Center have sounded the alarm and offer patients better care and more options for a problem doctors say is not only growing, but is not being taken seriously enough.

A need for options

Dr. Reginald Bell displays the LINX reflux management system

“Nexium was the second-top-selling prescription drug in the United States last year,” says Dr. Reginald Bell, referring to the purple acid-reducing pill, which surpassed $6 billion in sales, outdone only by the antipsychotic drug Abilify. Now doctors are learning that many of the people taking the acid-reducers (which include Prilosec) are not having their symptoms adequately controlled, which can be deadly.

“There are an increasing number of patients who started out with control of their symptoms who are now not getting relief,” says Dr. Ashwin Kurian, who specializes in GERD surgery at Swedish with Bell. “Many are showing signs of pre-cancer (Barrett’s esophagus) or getting cancer.” The increases are epidemic and concerning, particularly since esophageal cancer doesn’t have the survival rates of some other cancers, Bell says. “It’s not just about the number of people affected; it’s about the number of people who will likely die.”

Couple those statistics with studies that are beginning to question the long-term, high-dose use of these acid-reducing drugs for other health reasons, particularly for postmenopausal women with osteoporosis, and the number of patients wanting different options is growing. “I was really motivated to regain my health and get off the medications,” says Holmberg, who began researching options and found Bell, whose practice is one of a few in the country that offers a device called LINX. “He’s been kind of on the cutting-edge of treatments for GERD.”

Finding some relief

Holmberg opted for the LINX procedure a year and a half ago and says the only side effect was some swallowing difficulties the first month that went away. “The hardest part was getting insurance to cover it,” he says, an issue that comes with all new treatments. One caveat unique to the magnetic device: LINX patients cannot have standard MRI’s, although a new version of the device expected out this year will allow some use of the imaging system for LINX patients, Kurian says.

device is positioned around the lower esophageal sphincter, to prevent reflux of stomach acids

Holmberg, who points out that the device can be removed if necessary, is happy with his choice. “I’m just one case, but it has helped me get things under control. It’s not like a magic bullet per se, but it’s improved my quality of life. I still take some medicine but at a lower dose, and I’m actually trying to wean off of that now.”

Not everyone needs surgical procedures, and not everyone is a candidate. But anyone whose symptoms aren’t being controlled should be evaluated, Bell says. The new center will offer more comprehensive testing and treatment with a variety of specialists. Some patients might need more medication, bigger lifestyle changes or surgical options, Bell says. Holmberg’s best advice: Consider all options. “No matter what surgery or treatment people get done, that’s important. Do your research and find the experts.”

Did you know?

LPR (laryngopharyngeal acid reflux) is similar to GERD ̶ which often causes burning behind the breastbone and an acid-like taste in the mouth ̶ but can lead to more sinus, throat and voice issues than its more-recognized cousin.

Do you need more control your reflux disease?

Surgical options:

With reflux disorders, stomach acid comes up through the esophagus because of a faulty or weakened valve called the lower esophageal sphincter, or LES. These are just four of the medical treatments offered at Swedish Medical Center, where doctors help patients choose the procedure that is best for their condition. With each treatment, the majority of patients have reported high levels of satisfaction.

LINX(laparoscopic) A bracelet-like circle of linked titanium beads with magnetic cores is placed around the LES to aid in closing. The magnetic attraction causes closing after swallowing but will open to allow food to pass through.

Laparoscopic Fundoplication (sometimes called Nissen) As with traditional open GERD surgery, surgeons wrap part of the upper stomach around the lower esophagus to reduce acid reflux, but in a minimally-invasive fashion, leading to quicker recovery.

EsophyX® Device(incisionless) Using the device, inserted through a tube and guided down the esophagus via the mouth, surgeons reconstruct and tighten the LES with no incisions, meaning even faster recovery times.

Stretta (incisionless) A small catheter is passed through the mouth to the esophagus. Small electrodes providing radiofrequency waves are then threaded through, treating the muscle of the lower esophagus to decrease reflux.